When serious illness or disability strikes a person, the family as a whole is affected by the disease process and by the entire health care experience.3 Patients and families have different needs for education and counseling. Because each person in a family plays a specific role that is part of the family’s everyday functioning, the illness of one family member disrupts the whole family. When a family member becomes ill, other family members must alter their lifestyle and take on some of the role functions of the ill person, which in turn affects their own normal role functioning. If the person who does most of the family’s cooking has surgery and can’t shop or prepare meals for several weeks, other family members must take on this responsibility in addition to the tasks they already do. When a working parent is up most of the night trying to console a child with an ear infection, the parent not only loses sleep, but must either arrange for emergent child care or take a day off from work. If a man who is the primary income producer in a family has a heart attack, his wife may have to return to work, increase working hours if she is already employed, or become the family’s breadwinner. Middle aged adults whose children have just left home may need to alter their plans and goals to accommodate care needs for aging parents.
Illness may cause additional strain as the result of economic problems and interruptions in career development. If the patient is a young child, there may be additional strain to the family if there are siblings whose needs must also be met. Illness in the middle stage of family life, when adolescents are trying to break away from family ties and parents are going through their own mid-life transitions, may put further strain on what is already a time of potential family turmoil. Illness in later age may have an impact not only on grown children but also on the older couple who had anticipated a time of enjoyment together and are less able to care for each other because of their own physical limitations associated with aging.
The extent of family disruption depends on the seriousness of the illness, the family’s level of functioning before the illness, socioeconomic considerations, and the extent to which other family members can absorb the role of the person who is ill. In some instances, a major illness brings a family closer together; in others, even a minor illness causes significant strain. It is important to identify what the illness means, not only to the individual but also to the family. Asking them what they consider major problems and how they plan to handle specific situations can help you assess the meaning of the patient’s illness to the family.
To achieve effective patient teaching outcomes, you should make the family part of your teaching plan. For example, if your patient’s wife does all the cooking in the home, it is vital to include her in diet teaching. Involving family members may be an important future source of support for the patient as he or she works at behavioral change. Obviously it will be difficult for a husband to be supportive of his wife’s blood pressure treatment program if he does not understand the reasons for the recommendations and the consequences of not carrying them out.
Long-term illness, even in the most stable and supportive families, brings changes in family relationships. Illness produces disequilibrium in the family structure until adjustments can occur. If the nurse does not recognize the change, what it might mean to the patient and family, and how it might affect the patient’s willingness and ability to carry out health care recommendations, the goals of the teaching process will be diminished. When teaching the patient and family, it is important to identify patterns of relationships and to be alert to attitudes of family members. You may be able to identify resources within the group and help family members mobilize their resources to help the patient. It’s also important to be alert to some of the factors in family members that act as a barrier to education. Illness in a family member tends to raise the anxiety of all those close to the patient. Anxiety may be misinterpreted by the health professional as lack of interest or as reluctance to provide the patient with help and support. The more you are aware of these reactions and help family members deal with their feelings, the better able you will be to teach family members about the patient’s condition and treatment and to mobilize their support.